By Dr. Narine Singh
Chief Medical Officer (ag)
Ministry of Health

Pregnant women are at an increased risk for severe illness and are at a higher risk of certain complications from COVID-19 when compared with non-pregnant women with COVID-19 of the same age, including:
– An increased risk (about five times higher) of being admitted to a hospital.
– An increased risk (about two to three times higher) of being admitted to an Intensive Care Unit (ICU).
– An increased risk (about three times higher) of needing invasive ventilation (breathing life support).

During pregnancy, COVID-19 also increases the risk of complications for the newborn, including a slightly increased risk (about 1.5 times higher) of being born prematurely (before 37 weeks of pregnancy); an increased risk (nearly three times higher) of needing admission to a hospital newborn care unit.

Pregnant persons with certain underlying conditions are also more likely to be severely affected by COVID-19 than pregnant persons without these conditions. These conditions are: being older than 35 years, being overweight or obese (body mass index above 30 Kg/m2); having pre-existing (pre-pregnancy) high blood pressure; having pre-existing (pre-pregnancy) diabetes (type 1 or type 2).

Often, because pregnant patients are more frequently exposed to outpatient and hospital environments during prenatal visits and delivery, it, therefore, means that every pregnant patient then meets the World Health Organization criteria of being at high risk of exposure and increased risk for severe disease as compared to the general population.

The goal of any preventative prenatal intervention is to minimise risk to the fetus and mother while maximising health benefits. Vaccination presents an important strategy to mitigate illnesses of this population. There is precedent for immunisation during pregnancy in this context: tetanus, diphtheria, pertussis and influenza vaccines are routinely administered in the second or third trimester of pregnancy. Protecting the mother against infection is a primary benefit; pregnancy functionally immunosuppresses a patient and stresses cardiopulmonary systems. Secondary benefits to the fetus include preventing complications during delivery and transmitting protective antibodies transplacentally and through breastfeeding.

Although some live vaccinations, such as measles, mumps, rubella and varicella, are contraindicated in pregnancy, all current COVID-19 vaccines are composed of double stranded DNA or mRNA and do not carry the live virus. Clinical trials have demonstrated that vaccination is highly effective in preventing symptomatic COVID-19 in non-pregnant patients.

The potential harm to pregnant patients who experience peripartum infections includes increased risk of intensive care unit admission and maternal mortality. The potential harms to the baby include increased fetal growth restriction, preterm birth, and infant mortality. Notably, there is strong evidence that protective antibodies are transmitted to infants whose mothers survive perinatal infection and breastfeed. Vaccination, therefore, has a high likelihood of preventing severe COVID-19 disease and its adverse effects in both pregnant patients and their neonates.

The risks of administering COVID-19 vaccines during pregnancy appear to be minimal. Commonly reported side effects include short-term injection site pain, headache, fever, myalgia, arthralgia, chills, and nausea. None of the five vaccines being used in Guyana contain chemical components whose use is specifically contraindicated in pregnancy or breastfeeding.

Patients who fear the increased risk of miscarriage, congenital malformation, preterm delivery, or neonatal infection can be reassured that inactivated vaccines, such as the influenza vaccine, are frequently administered during pregnancy and have minimal risk of adverse events. Severe allergic reactions to past vaccines or known allergies to any COVID-19 vaccine components are contraindications to being immunised.

The World Health Organization (WHO), Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynaecologists (ACOG), Center for Disease Control and Prevention (CDC), Society of Obstetricians and Gynaecologists of Canada (SOGC), all support the use of vaccines in pregnancy and breastfeeding to reduce morbidity and mortality risk due to COVID-19.

The American College of Obstetricians and Gynaecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), the two leading organisations representing specialists in obstetric care in the US, recommends that all pregnant individuals be vaccinated against COVID-19. The organisations’ recommendations in support of vaccination during pregnancy reflect evidence demonstrating the safe use of the COVID-19 vaccines during pregnancy from tens of thousands of reporting individuals over the last several months, as well as the current low vaccination rates and concerning increase in cases.

Recent data from the Ministry of Health have shown that more than 95% of those hospitalised and/or dying from COVID-19 are unvaccinated. Pregnant individuals who have decided to wait until after delivery to be vaccinated may be inadvertently exposing themselves to an increased risk of severe illness or death. Those who have recently delivered and were not vaccinated during pregnancy are also strongly encouraged to get vaccinated as soon as possible.

As an experienced Obstetrician /Gynaecologist, I strongly recommend that the COVID-19 vaccine is the best method to reduce maternal and fetal complications of the COVID-19 infection among pregnant persons. There is strong evidence of the safe and effective use of vaccines during pregnancy because we know that COVID-19 infection puts pregnant persons at increased risk of severe complications. Vaccines are our single most effective tool against preventable viruses or diseases, including COVID-19.

The Office of the Chief Medical Officer strongly advocates for other practicing Obstetricians/Gynaecologists to recommend vaccination to their patients. It is clear from the current vaccination rates among pregnant persons in Guyana, the need for assurance and confidence in choosing vaccination and a strong recommendation from their obstetrician-gynaecologist could make a meaningful difference.

Pregnant persons should get vaccinated without delay because widespread uptake of the vaccines is the best chance to save lives and end this pandemic. Vaccination is safe before, during, or after pregnancy.